Abstract
We developed a simulation model to illustrate and evaluate the potential effects of opioid-related policies and interventions at the local (e.g., community) level. In the United States, the opioid epidemic was declared a national public health emergency in 2017 because of extremely large numbers of opioid-related overdose deaths. Overprescription of addictive opioid-based painkillers could lead to physical dependence with subsequent dose increase. Some patients switch to heroin to support their drug habit. The use of high doses of prescription opioids, heroin especially in combination with a more powerful synthetic opioid, fentanyl, can sometimes lead to overdose, which can be lethal. A number of prevention and treatment policies have been proposed and some implemented to fight the epidemic. These policies include prescription drug monitoring programs (PDMP), reduced initial opioid dose distribution of naloxone to counter overdose, medication-assisted treatment of problem users, and tamper-proof pills to prevent noncompliant behavior. The model describes the dynamics of opioid prescription and use in an interconnected community of pain patients. The model simulates individual patients’ life trajectories with respect to the use of opioids under different policies. The model includes potential policies based on the overdose and mortality rates of prescription opioid users, the overdose and mortality rates of heroin users, and the number of patients who turn to illicit means to acquire their drugs. Simulation study results show strong effects of naloxone use, very marginal short-term effects of PDMP compliance, and few to no positive effects of tamper-resistant medications on non-child opioid use trajectories.
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References
Rossen, L.M., Bastian, B., Warner, M., Khan, D., Chong, Y.: Drug poisoning mortality in the United States, 1999–2015 (2016). https://www.cdc.gov/nchs/data-visualization/drug-poisoning-mortality/
U.S. Department of Health and Human Services (HHS), Office of the Surgeon General: Facing Addiction in America: the Surgeon General’s Report on Alcohol, Drugs, and Health. HHS, Washington, DC, November 2016
Levy, B., et al.: Trends in opioid analgesic-prescribing rates by specialty, U.S., 2007–2012. Am. J. Prev. Med. 49(3), 409–413 (2015)
Volkow, N.D., et al.: Characteristics of opioid prescriptions in 2009. JAMA, J. Am. Med. Assoc. 305(13), 1299–1301 (2011)
Crane, E.H.: The CBHSQ report: emergency department visits involving narcotic pain relievers. Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality, Rockville, MD (2013)
Substance Abuse and Mental Health Services Administration: Key substance use and mental health indicators in the United States: results from the 2016 National Survey on Drug Use and Health (HHS Publication No. SMA 17-5044, NSDUH Series H-52). Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration, Rockville, MD (2017). https://www.samhsa.gov/data/
Ruhm, C.J.: Corrected US opioid-involved drug poisoning deaths and mortality rates, 1999–2015. Addiction (2018)
United States Congress, Senate Judiciary: S.524 - Comprehensive addiction and recovery act of 2016. In: 114th Congress, Washington (2016)
Kolodny, A., et al.: The prescription opioid and heroin crisis: a public health approach to an epidemic of addiction. Ann. Rev. Public Health 36, 559–574 (2015)
Dasgupta, N., Beletsky, L., Ciccarone, D.: Opioid crisis: no easy fix to its social and economic determinants. Am. J. Public Health 108(2), 182–186 (2018)
Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality: The NSDUH Report: Substance Use and Mental Health Estimates from the 2013 National Survey on Drug Use and Health: Overview of Findings. Substance Abuse and Mental Health Services Administration, Rockville, MD, 4 September 2014
Jones, C.M., et al.: National and state treatment need and capacity for opioid agonist medication-assisted treatment. Am. J. Public Health 105(8), e55–e63 (2015)
Maxwell, J.C.: The pain reliever and heroin epidemic in the united states: shifting winds in the perfect storm. J. Addict. Dis. 34(2–3), 127–140 (2015)
Cicero, T.J., et al.: The changing face of heroin use in the United States: a retrospective analysis of the past 50 years. JAMA Psychiatry 71(7), 821–826 (2014)
Mars, S.G., et al.: “Every ‘never’ I ever said came true”: transitions from opioid pills to heroin injecting. Int. J. Drug Policy 25(2), 257–266 (2014)
Inciardi, J.A., et al.: Prescription opioid abuse and diversion in an urban community: the results of an ultrarapid assessment. Pain Med. 10(3), 537–548 (2009)
Inciardi, J.A., Martin, S.S., Butzin, C.A.: Five-year outcomes of therapeutic community treatment of drug-involved offenders after release from prison. NCCD News 50(1), 88–107 (2004)
Dasgupta, N., et al.: Observed transition from opioid analgesic deaths toward heroin. Drug Alcohol Depend. 145, 238–241 (2014)
Zarkin, G.A., et al.: Benefits and costs of substance abuse treatment programs for state prison inmates: results from a lifetime simulation model. Health Econ. 21(6), 633–652 (2012)
Zarkin, G.A., et al.: Benefits and costs of methadone treatment: results from a lifetime simulation model. Health Econ. 14(11), 1133–1150 (2005)
Ritter, A., Shukla, N., Shanahan, M., Van Hoang, P., Cao, V.L., Perez, P., Farrell, M.: Building a microsimulation model of heroin use careers in Australia (2016)
Wakeland, W., et al.: Modeling the impact of simulated educational interventions on the use and abuse of pharmaceutical opioids in the United States: a report on initial efforts. Health Educ. Behav. 40(1 Suppl), 74s–86s (2013)
Wakeland, W., Nielsen, A., Geissert, P.: Dynamic model of nonmedical opioid use trajectories and potential policy interventions. Am. J. Drug Alcohol Abuse 41(6), 508–518 (2015)
U.S. Department of Health and Human Services: The Health Consequences of Smoking: 50 Years of Progress. A Report of the Surgeon General. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, Atlanta, GA, January 2014. Printed with corrections
Subramanian, S., Bobashev, G., Morris, R.J.: Modeling the cost-effectiveness of colorectal cancer screening: policy guidance based on patient preferences and compliance. Cancer Epidemiol. Biomarkers Prev. 18(7), 1971–1978 (2009)
Epstein, J.M., et al.: Controlling pandemic flu: the value of international air travel restrictions. PLoS One 2(5), e401 (2007)
Subramanian, S., et al.: Personalized medicine for prevention: can risk stratified screening decrease colorectal cancer mortality at an acceptable cost? Cancer Causes Control 28(4), 299–308 (2017)
Subramanian, S., Bobashev, G., Morris, R.J.: When budgets are tight, there are better options than colonoscopies for colorectal cancer screening. Health Aff. (Millwood) 29(9), 1734–1740 (2010)
Wilensky, U.: NetLogo. Center for Connected Learning and Computer-Based Modeling, Northwestern University, Evanston, IL (2017). http://ccl.northwestern.edu/netlogo/
Railsback, S.F., Grimm, V.: Agent-Based and Individual-Based Modeling. Princeton University Press, Princeton (2012)
Hoffer, L.D., Bobashev, G., Morris, R.J.: Researching a local heroin market as a complex adaptive system. Am. J. Community Psychol. 44(3–4), 273–286 (2009)
Hoffer, L., Bobashev, G.V., Morris, R.J.: Simulating patterns of heroin addiction within the social context of a local heroin market. In: Gutkin, B., Ahmed, S. (eds.) Computational Neuroscience of Drug Addiction. NEUROSCI, vol. 10, pp. 313–331. Springer, New York (2011). https://doi.org/10.1007/978-1-4614-0751-5_11
Leece, P., Orkin, A.M., Kahan, M.: Tamper-resistant drugs cannot solve the opioid crisis. CMAJ Can. Med. Assoc. J. 187(10), 717–718 (2015)
Cicero, T.J., Ellis, M.S.: Abuse-deterrent formulations and the prescription opioid abuse epidemic in the United States: lessons learned from OxyContin. JAMA Psychiatry 72(5), 424–430 (2015)
Romach, M.K., Schoedel, K.A., Sellers, E.M.: Update on tamper-resistant drug formulations. Drug Alcohol Depend. 130(1), 13–23 (2013)
Centers for Disease Control and Prevention: CDC guideline for prescribing opioids for chronic pain. Center for Disease Control and Prevention, Atlanta, GA (2017)
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Bobashev, G., Goree, S., Frank, J., Zule, W. (2018). Pain Town, an Agent-Based Model of Opioid Use Trajectories in a Small Community. In: Thomson, R., Dancy, C., Hyder, A., Bisgin, H. (eds) Social, Cultural, and Behavioral Modeling. SBP-BRiMS 2018. Lecture Notes in Computer Science(), vol 10899. Springer, Cham. https://doi.org/10.1007/978-3-319-93372-6_31
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DOI: https://doi.org/10.1007/978-3-319-93372-6_31
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